Current Issue : July - September Volume : 2018 Issue Number : 3 Articles : 5 Articles
Background. Opportunistic infections are common in organ transplant recipients. After 6 months of transplantation, patients have\nthe highest risk of opportunistic infections such as cryptococcosis. Case Presentation. The report presents the case of a 36-year-old\nfemale renal transplant recipient, with complaints of few subcutaneous painful and warm nodules and large, warm, erythematous,\nnontender plaques on the mildly edematous right leg and ankle. Incisional biopsy of the subcutaneous nodule over the leg showed\npanniculitis with small- to medium-sized vasculitis associated with round yeast forms, and culture of the fragments revealed\nC. neoformans var. grubii. Conclusions. This article also reviews in brief the treatment of this rare complication. Reviewing the\nliterature showed that since the cryptococcal cutaneous lesions are often nonspecific, the clinical picture solely is not enough to\nconstruct a definite diagnosis and there must be a high clinical suspicion....
Background. Despite earlier studies describing the feasibility of steroid weaning in heart transplant patients, themajority of patients\naremaintained on steroid therapy for life.We examined a strategy based on a singlemorning serumcortisol measurement. Methods.\nWe assigned stable posttransplant patients, who were maintained on tacrolimus, mycophenolate mofetil, and corticosteroids, into\none of two groups based on a screening morning cortisol level. Patients with a cortisol < 8 micrograms/deciliter were assigned to a\nââ?¬Å?maintenanceââ?¬Â group and the others were assigned to theweaning group and steroidswere tapered off over 4ââ?¬â??6weeks. Patients were\nmonitored on subsequent office visits for adrenal insufficiency and allograft rejection. Results. Thirty-one patients were enrolled\n(6 patients in the maintenance group and 25 in the steroid-weaning group). Mean follow-up was 10.2 Ã?± 4 years for the weaning\ngroup and 9.0 Ã?± 4.9 years in the maintenance group (...
Domino liver transplant has emerged as a viable strategy to increase the number of grafts available for transplantation. In the domino\ntransplant organs explanted fromone patient are transplanted into another patient. The first successful domino liver transplant was\nperformed in Portugal in 1995. Since then this innovative concept has been applied to several genetic or biochemical disorders that\nare treated by liver transplantation. An important consideration during this operation is that such livers can pose a risk of the de\nnovo development of the disease in the recipient. That is why this surgical procedure requires careful planning, proper selection of\nthe patients, and informed consent of both donor and recipient....
Efforts have been made by the transplant community to expand the deceased donor pool in paediatric liver transplantation (LT).\nThe growing experience on donation after circulatory death (DCD) for adult LT has encouraged its use also in children, albeit in\nselective cases, opening newperspectives for paediatric patients. Even though there has recently been a slight increase in the number\nof DCD livers transplanted in children, with satisfactory graft and patient outcomes, the use of DCD grafts in paediatric recipients\nis still controversial due to morbid outcomes associated with DCD grafts. In this context, recent advances in the optimization\nof donor support by extracorporeal membrane oxygenation and in the graft preservation by liver machine perfusion could find\napplication in order to expand the donor pool in paediatric LT. In the present study we review the current literature on DCD liver\ngrafts transplanted in children and on the use of extracorporeal donor support and liver perfusion machines in paediatrics, with\nthe aim of defining the current status and future perspectives of paediatric LT....
Allogeneic hematopoietic stem cell transplantation (HSCT) represents a curative treatment\nfor many patients with hematological malignant or non-malignant disorders. Evaluation of potential\ndonors for HSCT includes a rigorous assessment of the human leukocyte antigens (HLA) match\nstatus of family members, and the identification of suitable unrelated donors. Genes encoding\ntransplantation antigens are placed both within and outside the major histocompatibility complex\n(MHC). The human MHC is located on the short arm of chromosome 6 and contains a series of genes\nencoding two distinct types of highly polymorphic cell surface glycoproteins. Donors for HSCT are\nroutinely selected based on the level of matching for HLA-A, -B, -C, -DRB1, and -DQB1 loci. However,\ndisease relapse, graft-versus-host-disease, and infection remain significant risk factors of morbidity\nand mortality. In the same breath, in high-risk patients, graft-versus-leukemia effects inherent in HLA\nmismatching play a substantial immunological role to limit the recurrence of post-transplant disease.\nThe definition of a suitable donor is ever changing, shaped not only by current typing technology, but\nalso by the specific transplant procedure. Indeed, a more complete understanding of permissible HLA\nmismatches and the role of Killer Immunoglobulin-like receptors� genes increases the availability of\nHLA-haploidentical and unrelated donors....
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